II 111th CONGRESS 1st Session S. 1503 IN THE SENATE OF THE UNITED STATES July 22, 2009 Mrs. Gillibrand introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To establish grants to provide health services for improved nutrition, increased physical activity, obesity and eating disorder prevention, and for other purposes.

1.

Short title

This Act may be cited as the Improved Nutrition and Physical Activity Act or the IMPACT Act.

2.

Findings

Congress makes the following findings: (1)In July 2004, the Secretary of Health and Human Service recognized obesity is a critical public health problem in our country and under the Medicare program language was removed from the coverage manual stating that obesity is not an illness. (2)The National Health and Nutrition Examination Survey for 2002 found that an estimated 65 percent of adults are overweight and 31 percent of adults are obese and 16 percent of children and adolescents in the United States are overweight or obese. (3)The Institute of Medicine reported in Preventing Childhood Obesity (2004) that approximately 60 percent of obese children between 5 and 10 years of age have at least one cardiovascular disease risk factor and 25 percent have two or more such risk factors. (4)According to Centers for Disease Control and Prevention, children who are obese are at greater risk for psychological problems such as stigmatization and poor self-esteem. Obese children and adolescents are targets of early and systematic social discrimination. The psychological stress of social stigmatization can cause low self-esteem which, in turn, can hinder academic and social functioning, and persist into adulthood. (5)The Ophelia Project reports that approximately 30 percent of youth in the United States are estimated to be actively involved in bullying, either as a bully, target, or both. ABC News reports that 58 percent of children admit that someone has said mean or hurtful things to them online. The emotional safety of children who are overweight or obese is threatened since they are often the targets of bullying and relational aggression, which can have serious effects on their physical and emotional health. (6)The Institute of Medicine reports that the prevalence of overweight and obesity is increasing among all age groups. There is twice the number of overweight children between 2 and 5 years of age and adolescents between 12 and 19 years of age, and 3 times the number of children between 6 and 11 years of age as there were 30 years ago. (7)According to the Centers for Disease Control and Prevention, low income and minority girls have the highest rates of childhood obesity. Hispanic, African-American, and Native American children are disproportionately affected by obesity, with the highest prevalence found among African-American and Hispanic girls (The New Normal?: What Girls Say about Healthy Living 2006). (8)According to the 2004 Institute of Medicine report, obesity-associated annual hospital costs for children and youth more than tripled over 2 decades, rising from $35,000,000 in the period 1979 through 1981 to $127,000,000 in the period 1997 through 1999. (9)The Centers for Disease Control and Prevention reports have estimated that as many as 365,000 deaths a year are associated with being overweight or obese. Overweight and obesity are associated with an increased risk for heart disease (the leading cause of death), cancer (the second leading cause of death), diabetes (the sixth leading cause of death), and musculoskeletal disorders. (10)According to the National Institute of Diabetes and Digestive and Kidney Diseases, individuals who are obese have a 50 to 100 percent increased risk of premature death. (11)The Centers for Disease Control and Prevention reports that children spend a considerable amount of time with media. One study found that time spent watching TV, videos, DVDs, and movies averaged slightly over 3 hours per day among children aged 8–18 years. Several studies have found a positive association between the time spent viewing television and increased prevalence of obesity in children. This time with the media can damage girls’ physical and emotional health. The Geena Davis Institute on Gender in the Media reports that in many forms of media, girls and women are often depicted as sexualized objects, which can damage girls’ body images. (12)The Healthy People 2010 goals identify overweight and obesity as one of the Nation’s leading health problems and include objectives for increasing the proportion of adults who are at a healthy weight, reducing the proportion of adults who are obese, and reducing the proportion of children and adolescents who are overweight or obese. (13)Another goal of Healthy People 2010 is to eliminate health disparities among different segments of the population. Obesity is a health problem that disproportionally impacts medically underserved populations. (14)The 2005 Surgeon General’s report The Year of the Healthy Child lists the treatment and prevention of obesity as a national priority. (15)The Institute of Medicine report Preventing Childhood Obesity (2004) finds that childhood obesity is a serious nationwide health problem requiring urgent attention and a population-based prevention approach . . .. (16)The Centers for Disease Control and Prevention estimates the annual expenditures related to overweight and obesity in adults in the United States to be $264,000,000,000 (exceeding the cost of tobacco-related illnesses) and appears to be rising dramatically. This cost can potentially escalate markedly as obesity rates continue to rise and the medical complications of obesity are emerging at even younger ages. Therefore, the total disease burden will most likely increase, as well as the attendant health-related costs. (17)Weight control programs should promote a healthy lifestyle including regular physical activity and healthy eating, as consistently discussed and identified in a variety of public and private consensus documents, including the 2001 U.S. Surgeon General’s report A Call To Action and other documents prepared by the Department of Health and Human Services and other agencies. (18)The Institute of Medicine reports that poor eating habits are a risk factor for the development of eating disorders and obesity. In 2002, more than 35,000,000 Americans experienced limited access to nutritious food on a regular basis. The availability of high-calorie, low-nutrient foods have increased in low-income neighborhoods due to many factors. (19)Effective interventions for promoting healthy eating behaviors should promote healthy lifestyle and not inadvertently promote unhealthy weight management techniques. (20)The National Institutes of Health reports that eating disorders are commonly associated with substantial psychological problems, including depression, substance abuse, and suicide. (21)The National Association of Anorexia Nervosa and Associated Disorders estimates there are 8,000,000 Americans experience eating disorders. Eating disorders of all types are more common in women than men. (22)The health risks of Binge Eating Disorder are those associated with obesity and include heart disease, gall bladder disease, and diabetes. (23)According to the National Institute of Mental Health, Binge Eating Disorder is characterized by frequent episodes of uncontrolled overeating, with an estimated 2 to 5 percent of Americans experiencing this disorder in a 6-month period. (24)Additionally, the National Institute of Mental Health reports that Anorexia Nervosa, an eating disorder from which 0.5 to 3.7 percent of American women will suffer in their lifetime, is associated with serious health consequences including heart failure, kidney failure, osteoporosis, and death. According to the National Institute of Mental Health, Anorexia Nervosa has one of the highest mortality rates of all psychiatric disorders, placing a young woman with Anorexia Nervosa at 12 times the risk of death of other women her age. (25)In 2001, the National Institute of Mental Health reported that 1.1 to 4.2 percent of American women will suffer from Bulimia Nervosa in their lifetime. Bulimia Nervosa is an eating disorder that is associated with cardiac, gastrointestinal, and dental problems, including irregular heartbeats, gastric ruptures, peptic ulcers, and tooth decay. (26)On the 2007 Youth Risk Behavior Survey, 4.3 percent of high school students reported recent use of laxatives or vomiting to control their weight. (27)The Girl Scout Research Institute found that most girls have a holistic view of health and believe physical and emotional health are of equal importance. This connection is reflected in their behavior and attitudes toward diet and exercise. Diet and exercise patterns are linked to emotional health, self-esteem, and body image, which all play a critical role in how girls define health (The New Normal?: What Girls Say about Healthy Living 2006). (28)A strict focus on physical health does not resonate emotionally with girls. Any reframing or redefining of health needs, including nutrition and physical activity, needs to focus on the positive emotional outcomes that are likely to result from healthy behavior (other than maintaining normal weight and eating nourishing foods). For girls, being healthy means not only eating right and looking good, but also feeling good about oneself and having a good relationship with one’s peers (The New Normal?: What Girls Say about Healthy Living 2006). (29)The Girl Scout Research Institute reports that emotional safety is a top concern for girls. Relational aggression, or emotional bullying, threatens girls’ emotional and physical safety. Efforts to improve girls’ health should include the prevention of relational aggression, since most girls define safety in terms of relationships and healthy relationships are crucial to girls’ physical and emotional health (Feeling Safe: What Girls Say 2003 and The New Normal?: What Girls Say about Healthy Living 2006). (30)Girls’ body images affect their emotional and physical health, such as self-esteem and eating and exercise habits. External factors such as family, celebrities, and the media also have an effect on girls’ perception of their bodies. Therefore, promoting healthy media images of girls and woman can help improve their physical and emotional health (The New Normal?: What Girls Say about Healthy Living 2006). (31)According to the Girl Scout Research Institute, parents—especially mothers in the case of girls—are important influences and role models. Efforts to inspire and motive girls to make healthier choices must focus on helping parents support their children and teach parents that their choices model behaviors for how to live a healthy life (The New Normal?: What Girls Say about Healthy Living 2006). (32)There is a tension between health awareness and behavior among children and youth. Although girls demonstrate basic knowledge about healthy foods and eating behaviors, they are not putting this knowledge into practice and it is normal for many girls to make poor choices with respect to diet and exercise. Teaching healthy nutrition and exercise habits should make healthy living seem reasonable, socially acceptable, applicable and attainable (The New Normal?: What Girls Say about Healthy Living 2006). (33)According to the American Academy of Pediatrics, the current epidemic of inactivity and the associated epidemic of obesity are being driven by multiple factors (societal, technologic, industrial, commercial, financial) and must be addressed likewise on several fronts. Success is more likely to be achieved by the implementation of sustainable, economically viable, culturally acceptable active-living policies that can be integrated into multiple sectors of society (Pediatrics Vol. 117 No. 5 May 2006, pp. 1834–1842 (doi:10.1542/peds.2006–0472) (Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity)). (34)According to the 2006 School Health Policies and Programs Study, conducted by the Centers for Disease Control and Prevention, only 3.8 percent of elementary schools, 7.9 percent of middle schools, and 2.1 percent of high schools provided daily physical education or its equivalent for the entire school year for students in all grades. Overall, about 22 percent of schools did not require students to take any physical education. (35)Additionally, the 2006 School Health Policies and Programs Study revealed that 64.4 percent of schools with primary responsibility for food preparation reported they did not reduce the amount of fats and oils used in recipes or use low-fat recipes when preparing school meals. Nationwide, 21.1 percent of elementary schools, 62.4 percent of middle schools, and 85.8 percent of high schools had one or more vending machines from which students could purchase food or beverages. (36)The Institute of Medicine reports that taking action against childhood obesity must address the factors that influence both eating and physical activity. According to the Institute of Medicine, [a]lthough a number of organizations, industries, institutions, and agencies must be involved in designing and implementing changes, efforts cannot succeed unless they also engage the families, schools, and communities that create the environments in which children live and their behaviors are formed.